South-Western Legal Studies in Business

Physician Able to Perform Some Medical Services Not Totally Disabled
Description Maine high court held that a physician who was unable to perform major surgery, but could perform examinations, was not totally disabled, and so could not qualify for disability insurance from his carrier.
Topic Insurance
Key Words Disability; Depression
C A S E   S U M M A R Y
Facts Giustra is an orthopedic surgeon who suffered from depression. His psychiatrist determined that he could examine patients and do minor surgery, but should not do major surgery. Giustra filed a claim under his disability insurance policy for total disability. The company denied his claim. Giustra sued to enforce the policy, but the trial court held for the insurer. Giustra appealed.

Affirmed. Giustra was still able to do one or more of the important duties of an orthopedic surgeon and, thus, was not totally disabled within the terms of the policy. The policy was for total disability, which does not apply in his case. It may be that his income will be lower due to his inability to perform surgery, but that does not qualify as total disability given he can still practice medicine.

Citation Giustra v. UNUM Life Insurance Co. of America, --- A.2d --- (2003 WL 157375, Sup. Ct., Maine, 2003)

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